Can cutaneous functional units be used to predict therapy requirements in paediatric palm burns? Towards zero contractures.

Rhianydd Thomas^1,2, Stephanie Wicks¹, Marita Dale³, Claire Toose¹, Verity Pacey²,
¹Children’s Hospital At Westmead NSW, Australia
²Macquarie University NSW, Australia
³University of Sydney NSW, Australia

Abstract

Background: Palmar burn injuries are common in young children and can result in contracture with significant functional complications.

Methods: A prospective longitudinal study was completed to describe outcomes of palm and digit extension splint use following palmar burn in 75 children (83 hands) aged <5 years and determine whether specific palmar cutaneous functional units (CFUs) are associated with development of early signs of contracture (ESC) and contracture. Range of motion, scar, developmental and quality of life outcomes were assessed at 3-6 months and 9-18 months following burn. Routine clinical data, including splint use and other scar management interventions, was collected at therapy reviews. Results: Children were splinted 21 hours/day for a mean of 94 days following burn. The mean time to transition to overnight splinting was 158 days and splint cessation was 264 days following burn. Fourteen hands developed ESC (17%): 12 hands had full ROM restored following conservative management, 2 hands (3%) progressed to contracture. Hands that developed ESC had significantly greater healing time (p=0.002), greater number of CFUs affected (p<0.001), and greater number of immediate first webspace and extended first webspace CFUs affected (p=0.002 and p<0.001 respectively). Risk of ESC increases for each additional day to heal (odds ratio 1.1, 95% CI 1.0-1.2) and for each additional CFU affected in the extended first webspace (odds ratio 2.8, 95% CI 1.5-5.0). Conclusion: Early and intensive splinting following palmar burn results in excellent ROM outcomes. Burns involving more CFUs and first webspace CFUs have an increased risk of contracture.

Biography

Rhi is a physiotherapist at the Children’s Hospital at Westmead and a PhD candidate at Macquarie University. Her research is focused on splinting following palmar burn injury in young children to prevent contracture.